Traffic jam

After a glitch-plagued first week of enrollment on the state and federally run insurance exchanges, many observers are wondering whether more technical problems are still to come and whether consumers will keep doggedly trying to sign up for coverage. Making matters worse, healthcare providers and community groups helping Americans sign up also faced hurdles due to delays in training, state certification and problems with exchange websites.

Paula Borman, a 47-year old administrator at a Chicago not-for-profit organization, said she tried on and off for two days to access the federal government's website but had no luck. “The first time I tried, it was down, and the second time, I started to put in my information and then it logged me out,” she said.

But Borman, who was born with spina bifida, said she'll keep trying. “I'm actually encouraged by the delays,” she said. “It shows people are using it.”

By the end of the week, as the federal government had added more computer servers, insurers and individuals reported some cases of successful online enrollment.

The good news for supporters of the Patient Protection and Affordable Care Act was the unexpectedly heavy public interest in visiting the exchange websites and phoning the call centers as soon as they opened Oct. 1. By the end of day one, HealthCare.gov had more than 4.7 million unique visitors, a figure that jumped to 7 million as of Oct. 2. That undercut arguments that Americans don't want or need the reform law. On the other hand, the technical difficulties highlighted the peril that if Americans come to see the law as a flop, its foes may have an easier time gutting it.

The open enrollment period extends through March 31, 2014, and consumers must sign up by Dec. 15 to obtain coverage by Jan. 1.

“There were five times more users in the marketplace this morning than have ever been on Medicare.gov at one time,” President Barack Obama said Oct. 1. “That gives you a sense of how important this is to millions of Americans around the country, and that's a good thing.”

Many visitors to the federal HealthCare.gov website last week were met with messages informing them that the system was down or asking them to wait until they could be redirected to the login page. Acknowledging the delays, HHS officials urged patience and said they were working hard to address the problems. “With any new product launch, there will be glitches,” said CMS Administrator Marilyn Tavenner, during an Oct. 1 call with reporters. “As things arise, we will fix them.”

In an Oct. 3 e-mail, HHS spokeswoman Joanne Peters said experts had been “working around the clock and were able to expand system capacity somewhat overnight, cutting by one-third the volume of people waiting to apply.”

Obama noted that Apple recently found glitches in its new mobile operating system. “They found a glitch, so they fixed it,” he said. “I don't remember anybody suggesting Apple should stop selling iPhones or iPads or threatening to shut down the company if they didn't.”

But experts say the rough start highlights the daunting task of creating a sophisticated online enrollment system capable of communicating and connecting with a range of government agencies and processing huge amounts of user data.

“With a project of this size and magnitude, the reality is there will be technical challenges,” said Dan Schuyler, director of exchange technology at Leavitt Partners, which has worked with a number of state-run exchanges. “I thought there would be problems determining eligibility for premium subsidies. I didn't anticipate that you wouldn't even be able to create an account.”

He contends that federal and state officials and their contractors didn't have enough time to adequately build the exchanges and do the necessary testing. Other experts say the government lacked enough computer servers for the volume of traffic and data. “It's very concerning,” Schuyler added. “If we're seeing these kinds of difficulties now, what happens down the road when the processes are more complicated?”

As it worked to correct system issues, HHS released data Oct. 1 showing available insurance plans and premiums across the 36 states where the federal government fully or partly runs the exchanges. According to the data, 140 insurance issuers are offering more than 1,700 different health plans, although choice and prices vary widely from one region to another. HHS declined to provide initial enrollment figures for the federally run exchanges but said it does plan to release such numbers regularly.

The rollout of state-run exchanges in 16 states including the District of Columbia was a mixed success, with some experiencing site crashes and long delays and others reporting impressive first-day enrollment figures. Kentucky's insurance exchange, Kynect, was more successful than most, with roughly 110,000 unique visitors to its site and nearly 11,000 applications for coverage underway by 4 p.m. EDT on Oct. 2, according to state officials. As of 8 p.m. MDT on Oct. 1, Colorado's exchange, Connect for Health Colorado, had had 12 million hits and 79,000 visitors to its site, with 5,500 accounts created.

Insurers said they were focusing on getting an accurate fix on the number of new enrollees amid technical issues. Some companies are encouraging consumers to go to their own websites to comparison shop.

Scott Keefer, vice president of policy and legislative affairs for Blue Cross and Blue Shield of Minnesota, said the opening of the state's exchange, MNSure, was “as anticipated, with some technical bumps in the road.” He said his company was working with the state to make sure that enrollment information gets to Blue Cross as quickly as possible, “so that we can 'see' new members in our system when they call with questions.”

Anne Filipic, president of Enroll America, said Americans were undeterred by system outages and other technical hurdles. The pro-ACA group has targeted 10 states for aggressive sign-up efforts. “Consumers remain enthusiastic,” said Filipic, during an Oct. 3 call with reporters.

The media call also included remarks from Daniel McNaughton, 22, a student from Orlando, Fla., who was able to log in to the HealthCare.gov site and compare more than 100 plans before ultimately signing up for a gold-level plan that will cost him $70 a month, including the federal premium tax credit he is eligible for.

Obama predicted that many more Americans would sign up when they visit the exchange websites and find they can buy affordable coverage. “Tens of thousands of Americans die each year just because they don't have health insurance,” he said in his Oct. 1 speech. “Millions more live with the fear that they'll go broke if they get sick. And today we begin to free millions of our fellow Americans from that fear.”

Follow Maureen McKinney on Twitter: @MHMMcKinney